MEDICARE: BASHER M ATIQUZZAMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME89652	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00392759	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033159819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASHER M ATIQUZZAMAN M.D.

Provider Business Mailing Address
First Line	:	2400 N ORANGE BLOSSOM TRAIL
Second Line	:	SUITE 302
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-2308
Country	:	US
Telephone Number	:	407-932-6193
Fax Number	:	407-932-6194

Provider Business Practice Location Address
First Line	:	2400 N ORANGE BLOSSOM TRAIL
Second Line	:	SUITE 302
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-2308
Country	:	US
Telephone Number	:	407-932-6193
Fax Number	:	407-932-6194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/06/2013

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Directions to “ BASHER M ATIQUZZAMAN M.D.” Practice Location

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